Clinical diagnosis and treatment analysis of spontaneous cerebrospinal fluid otorrhoea
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摘要: 目的 探讨自发性脑脊液耳漏的临床特点、影像学表现、手术方法及诊治经验。方法 回顾性分析2018年5月至2023年5月手术治疗的11例自发性脑脊液耳漏患者的临床资料，包括既往病史，影像学资料、漏口位置、手术修补方法、治疗效果及术后随访情况等。结果 11例手术患者，其中4例患者首诊为分泌性中耳炎，1例患者首诊为化脓性中耳炎，5例患者既往有脑膜炎病史或因脑膜炎为初次诊断而就诊；经耳道径路修补脑脊液漏2例，经乳突径路修补脑脊液漏9例；术中发现漏口位于镫骨底板4例，窦脑膜角1例，颅后窝合并颅中窝1例，颅中窝4例，内听道底及面神经管迷路段1例；10例患者1次修补成功，另1例患者术后出现颅内高压，最终行侧脑室腹腔分流术后症状解除。术后随访6个月~4年，无脑脊液耳漏及脑膜炎复发。结论 自发性脑脊液耳漏发病率低，临床症状不典型，延迟诊断或漏诊误诊率高；手术是目前治疗自发性脑脊液耳漏首选方法，通常可以取得满意的效果；诊疗过程中要警惕并重视颅内高压的存在，防止发生严重并发症及不可逆损伤。Abstract: Objective To investigate the clinical features, imaging findings, surgical methods, diagnostic and treatment experience of spontaneous cerebrospinal fluid otorrhoea.Methods The clinical data of 11 patients with spontaneous cerebrospinal fluid otorrhoea treated surgically at our hospital from May 2018 to May 2023 were retrospectively analyzed. The medical data included medical history, imaging data, leak location, surgical repair method, treatment effect and postoperative follow-up.Results Among the 11 surgical patients, 4 patients were initially diagnosed with secretory otitis media, 1 was initially diagnosed with purulent otitis media, and 5 patients had a history of meningitis or presented because meningitis as the initial diagnosis. There were 2 cases of cerebrospinal fluid leakage repaired through the ear canal pathway and 9 cases of cerebrospinal fluid leakage repaired through the mastoid pathway. During the operation, leaks were located in the stapes floor plate in 4 cases, sinus meningeal angle in 1 case, posterior cranial fossa combined with middle cranial fossa in 1 case, middle cranial fossa in 4 cases, and labyrinthine segment of the internal auditory canal and facial nerve canal in 1 case. Ten patient was successfully repaired, and another patient developed intracranial hypertension after surgery, with symptoms alleviated by a lateral ventriculoperitoneal shunt. Postoperative follow-up ranged from 6 months to 4 years, and there was no CSF otorrhoea and meningitis recurrence.Conclusion The incidence of spontaneous cerebrospinal fluid otorrhea is low, the clinical symptoms are atypical, and the rate of delayed diagnosis or missed diagnosis and misdiagnosis is high. Surgery is currently the preferred treatment for spontaneous cerebrospinal fluid otorrhoea, and satisfactory results are usually achieved; During diagnosis and treatment, it is crucial to be vigilant for intracranial hypertension to prevent serious complications and irreversible damage.
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Key words:
- cerebrospinal fluid otorrhoea /
- spontaneity /
- intracranial hypertension /
- meningitis
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表 1 11例经手术治疗的自发性脑脊液耳漏患者的临床资料
患者 性别 年龄/岁 脑膜炎病史 听力情况 术前影像学发现 手术径路 漏口位置 修复材料 术后并发症 随访时间/年 1 女 7 有 SNHL IP-Ⅰ 乳突径路 镫骨底板 颞肌 无 4.0 2 男 8 有 SNHL IP-Ⅰ 乳突径路 镫骨底板 颞肌 无 2.0 3 男 4 有 SNHL IP-Ⅱ 耳道径路 镫骨底板 颞肌 无 1.0 4 女 12 有 SNHL IP-Ⅰ 耳道径路 镫骨底板 颞肌 无 1.0 5 女 48 无 CHL 颅中窝部分骨质筛孔样、蜂窝样改变 乳突径路 颅中窝 筋膜+颞肌+软骨 无 1.0 6 男 57 无 CHL 无 乳突径路 颅中窝 筋膜+颞肌 无 2.0 7 男 16 有 SNHL 内听道底、面神经迷路段及乳突部分骨质溶骨性改变 乳突径路 内听道底及面神经管迷路段 脂肪 颅高压症 2.0 8 男 51 无 CHL 颅中窝及颅后窝部分骨质筛孔样、蜂窝样改变 乳突径路 颅中窝+颅后窝 脂肪 无 2.0 9 女 47 无 CHL 无 乳突径路 窦脑膜角 筋膜+颞肌 无 0.5 10 男 53 无 CHL 颅中窝部分骨质筛孔样、蜂窝样改变 乳突径路 颅中窝 筋膜+颞肌 无 3.0 11 男 48 无 CHL 颅中窝底部分骨质筛孔样、蜂窝样改变 乳突径路 颅中窝 筋膜+颞肌+软骨 无 1.0 CHL：传导性聋；SNHL：感音神经性聋。 
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[1] 中华医学会神经外科学分会. 脑脊液漏规范化管理中国专家共识[J]. 中华医学杂志, 2022, 102(15): 1057-1068.
[2] 刘静, 梅凌云, 贺楚峰, 等. 成人和儿童自发性脑脊液耳漏差异分析[J]. 临床耳鼻咽喉头颈外科杂志, 2016, 30(22): 1785-1789. https://lceh.whuhzzs.com/article/doi/10.13201/j.issn.1001-1781.2016.22.010
[3] Daneshi A, Ajalloueyan M, Ghasemi MM, et al. Complications in a series of 4400 paediatric cochlear implantation[J]. Int J Pediatr Otorhinolaryngol, 2015, 79(9): 1401-1403. doi: 10.1016/j.ijporl.2015.05.035
[4] Stevens SM, Crane R, Pensak ML, et al. Analysis of audiometric outcomes following combined middle cranial Fossa/transmastoid approaches for spontaneous cerebrospinal fluid otorrhea[J]. Otolaryngol Head Neck Surg, 2017, 156(5): 924-932. doi: 10.1177/0194599817690726
[5] 管业箫, 宗世民, 肖红俊. 自发性脑脊液耳漏的诊断与治疗[J]. 临床耳鼻咽喉头颈外科杂志, 2017, 31(20): 1617-1621. https://lceh.whuhzzs.com/article/doi/10.13201/j.issn.1001-1781.2017.20.019
[6] Muzzi E, Battelino S, Gregori M, et al. Life-threatening unilateral hearing impairments. Review of the literature on the association between inner ear malformations and meningitis[J]. Int J Pediatr Otorhinolaryngol, 2015, 79(12): 1969-1974. doi: 10.1016/j.ijporl.2015.09.028
[7] 吴宏, 蔡鑫章. 内耳畸形致脑脊液耳漏的诊疗进展[J]. 临床耳鼻咽喉头颈外科杂志, 2021, 35(11): 1048-1052. https://lceh.whuhzzs.com/article/doi/10.13201/j.issn.2096-7993.2021.11.019
[8] Mafee MF, Bradley WG, Almutairi A, et al. Arachnoid granulations and spontaneous cerebrospinal fluid otorrhea: Role of imaging[J]. Oper Tech Otolaryngol Head Neck Surg, 2014, 25(1): 74-86. doi: 10.1016/j.otot.2013.11.010
[9] Yew M, Dubbs B, Tong O, et al. Arachnoid granulations of the temporal bone: a histologic study of dural and osseous penetration[J]. Otol Neurotol, 2011, 32(4): 602-609. doi: 10.1097/MAO.0b013e3182129026
[10] 王希, 冯国栋, 田旭, 等. 儿童自发性脑脊液漏2例[J]. 中华耳鼻咽喉头颈外科杂志, 2022, 57(8): 991-994.
[11] Lobo BC, Baumanis MM, Nelson RF. Surgical repair of spontaneous cerebrospinal fluid(CSF)leaks: a systematic review[J]. Laryngoscope Investig Otolaryngol, 2017, 2(5): 215-224. doi: 10.1002/lio2.75
[12] 陈敏, 刘薇, 杨扬, 等. 儿童内耳畸形相关脑脊液耳漏的手术治疗[J]. 临床耳鼻咽喉头颈外科杂志, 2022, 36(10): 788-792. https://lceh.whuhzzs.com/article/doi/10.13201/j.issn.2096-7993.2022.10.012
[13] Bidot S, Levy JM, Saindane AM, et al. Spontaneous skull base cerebrospinal fluid leaks and their relationship to idiopathic intracranial hypertension[J]. Am J Rhinol Allergy, 2021, 35(1): 36-43. doi: 10.1177/1945892420932490
[14] Allen KP, Perez CL, Kutz JW, et al. Elevated intracranial pressure in patients with spontaneous cerebrospinal fluid otorrhea[J]. Laryngoscope, 2014, 124(1): 251-254. doi: 10.1002/lary.24251
[15] Vivas EX, Mccall A, Raz Y, et al. ICP, BMI, surgical repair, and CSF diversion in patients presenting with spontaneous CSF otorrhea[J]. Otol Neurotol, 2014, 35(2): 344-347. doi: 10.1097/MAO.0b013e3182a473cf
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